| Neurotech Inc | |
|
930 Kingsley Ave Orange Park FL 32073 | |
| (904) 269-0500 | |
| (904) 269-9805 |
| Full Name | Neurotech Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 930 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Charles W Laskey (FINANCIAL OPERATOR) |
| Authorized Official Contact | 9042690500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurotech Inc 930 Kingsley Ave Orange Park FL 32073 Ph: (904) 269-0500 | Neurotech Inc 930 Kingsley Ave Orange Park FL 32073 Ph: (904) 269-0500 |
| NPI Number | 1396828448 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5890735930 |
|---|---|
| Medicare Enrollment ID | O20111018000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396828448 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph M Shaughnessy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336236900 PECOS PAC ID: 9638119399 Enrollment ID: I20070724000378 |
| Provider Name | Casey L Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245587393 PECOS PAC ID: 6406005669 Enrollment ID: I20121003000202 |
| Provider Name | Sarah E Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316186166 PECOS PAC ID: 9133267354 Enrollment ID: I20190607000939 |
| Provider Name | Michele L. Bannister |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669000105 PECOS PAC ID: 2961890074 Enrollment ID: I20211022000164 |
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